Provider Demographics
NPI:1306225768
Name:FISHER, KAYLA ROSE (COTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:FISHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 3RD AVE SW
Mailing Address - Street 2:D8
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-3467
Mailing Address - Country:US
Mailing Address - Phone:605-295-3682
Mailing Address - Fax:
Practice Address - Street 1:2150 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8472
Practice Address - Country:US
Practice Address - Phone:928-763-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant